Guidelines for a Palliative Approach in Residential Aged Care

(ii)
Specialised palliative service provision
This form of palliative care involves referral to a specialised palliative team or health care
practitioner. However, this does not replace a palliative approach but rather augments it with
focused, intermittent, specific input as required. The goals are:
• assessing and treating complex symptoms experienced by the resident; and
• providing information and advice on complex issues (e.g. ethical dilemmas, family issues, or
psychological or existential distress) to the aged care team.
(iii)
End-of-life (terminal) care
This form of palliative care is appropriate when the resident is in the final days or weeks of life
and care decisions may need to be reviewed more frequently. Goals are more sharply focused on
the resident’s physical, emotional and spiritual comfort, and support for the family.
Identifying when a resident is moving into a terminal phase will assist the aged care team
to provide appropriate care and communication. However, this decision is not easily made,
because there are few clear indicators to identify when a person should be considered to be in
the terminal phase of an illness or ageing process. This is particularly difficult when the resident
has a number of co-morbidities (for further discussion see Section 2.2.1, ‘Prognostication’).
The aged care team needs to acknowledge the important role of the family carers, to respect
the choices that the resident and their family make about treatment options, and endeavour
to anticipate the needs of those involved [19] (Level QE). Careful attention to the following
characteristics will assist the aged care team in taking a palliative approach to resident care:
• being available to discuss issues with the individual and family members;
• providing information in a proactive way; and
• having a sense of partnership with people and their families [20] (Level QE).
McGrath (2001) reported that families especially valued receiving information from the aged
care team when death was imminent, so they could prepare for the resident’s death [19] (Level
QE). Reynolds and colleagues (2002) [21] (Level QE) described the needs of residents dying in
RACFs following interviews with staff and family after the death of a resident. They found that
the most common physical problems were pain, personal cleanliness, dyspnoea, incontinence
and fatigue. Respondents felt that there could have been more treatment for emotional
symptoms such as depression, anxiety and loneliness.
The following indicators are provided to help the aged care team determine when to discuss
end-of-life matters with the resident and family. These indicators are not prescriptive, nor
should they be used in place of careful, individualised assessment of each resident.
Symptoms that are considered to indicate a terminal phase of life include [22] (Level IV):
• Requiring frequent intervention
• Being bed-bound
• Loss of appetite
38 Guidelines for a Palliative Approach in Residential Aged Care